Provider Demographics
NPI:1073575783
Name:ALDRICH, ROBERT ENNES JR (PA-C)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ENNES
Last Name:ALDRICH
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21686
Mailing Address - Street 2:C/O UNITED SURGICAL ASSISTANTS
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33622-1686
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12880 COMMODITY PL
Practice Address - Street 2:C/O UNITED SURGICAL ASSISTANTS
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-3101
Practice Address - Country:US
Practice Address - Phone:877-872-5788
Practice Address - Fax:866-698-7272
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102781363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00224203OtherRAILROAD MEDICARE
R97826Medicare UPIN
FLU3448ZMedicare PIN
P00224203OtherRAILROAD MEDICARE
FLU3448XMedicare PIN